Rotator cuff surgery continues to evolve. Initially surgery was performed using transosseous techniques. The advent of anchors enabled the procedures to be performed arthroscopically. Prior art approaches typically use either single or double row repair techniques with knotted sutures. The sutures act to hold the tendon next to the bone during the healing process.
The evolution has gone from single row to double row repairs. However, these constructs require surgeons to know how to tie complicated knots which are technically challenging. The suture knots in the tissue can be bulky and create a painful impingement of the tendon on the bone. This is because the knots end up on top of the cuff, in the sub-acromial space, and have the opportunity to rub on the acromion as the arm is raised. Because non-absorbable suture materials are used for these types of repairs, the suture and associated knots are not absorbed into the body, and hence provide a constant, painful reminder of their presence. Furthermore, there are issues surrounding the use of tying knots which include knot security and loop security. There is also the potential for these knots to increase the chance of tissue reaction. Another concern is the potential for knots to create a “clicking” sound associated with patient irritation.
Better instruments and improved anchor designs facilitated knotless single row configurations. Next, double row transosseous equivalent repairs were developed. Many of these techniques still require complicated knots. Again, the problems previously described with knots are still issues of this technique. One potential advantage of this technique is that there is independent medial row fixation. Another derivative of this repair construct is a knotless “bridge” technique. While this technique eliminates the need to tie knots, the medial and lateral row fixation is dependent on one another. In other words, if the lateral row fails then so does the corresponding medial row. An arthroscopic technique that enables a truly knotless double row transosseous repair with application of medial pressure is desirable. An improved suture system and methods of using such a suture system would address the concerns previously described and would also allow for surgeons of various skill levels to perform the technique arthroscopically and without the need for knot tying.